Steven Whitman, PhD, director of the Sinai Urban Health Institute in Chicago, is the winner of the 2012 Helen Rodriguez-Trìas Social Justice Award. The award honors public health professionals who have worked toward social justice for underserved and disadvantage populations. In his more than four decades working in public health, Whitman has used and continues to use science to call for action against social inequity and racism and to work also on improving women’s and children’s health and improve access to care. In this conversation with Public Health newswire, he explains ways the public health community can work toward improved social justice.
You are known by your colleagues as someone who challenges conventional thinking about health inequity by emphasizing two things: that change requires not only analysis but also courage and the will to genuinely engage communities. How do we engage communities, especially those that have long been ignored?
The key to engaging communities is to be genuine and passionate in their defense and supportive in their pursuit of good health. I have noted over the years that many researchers, medical centers, etc., simply use “community engagement” because their granting agencies tell them that such engagement is mandatory. Thus, people and institutions who have never cared about the community now act as if they do. If this behavior is not genuine, the community will realize this and act accordingly. I thus propose a couple of tests. How many researchers live in the communities they research? How many people who work at these research centers are the same race/ethnicity and class as the people in the communities? Why such under-representation? How will the people of the community benefit from the research? Only when these issues (and many more like them) are satisfactorily resolved will we have genuine community engagement.
Do you feel that public health research is increasingly exploring community-based interventions to improve health? Is this one key to address health inequity?
Some public health research is exploring community-based interventions, but most is not. Most such research remains in the walls of hospitals, clinics, etc. If we are to effectively address health inequity we must burst out of this institution-based model and into the community. We must work with people before they become “patients” and work with them where they live their lives – in their communities, at their jobs, etc. Complete access to quality health care is essential, but reaching people before they come through our health care doors is also essential. The CEO of the Sinai Health System, Alan Channing, calls this the pursuit of “pre-primary care.” Nothing in my mind could be more important.
How can we better our progress in eliminating or at least reducing health disparities?
There are two inter-related paths to reducing health disparities. First, we should attack those systemic or fundamental causes that are responsible for the disparities – issues like racism, poverty, gender barriers, etc. We should fight against these factors whenever and wherever we can. Simultaneously, we should put in place effective interventions, in true coordination with the affected communities. These interventions should be transparently implemented and evaluated, always with the community. If they are successful we should replicate them. If they aren’t, we should go back to the drawing board and devise more effective interventions.
How can the public health community as a whole help improve access to care?
The United States is the only industrialized county in the world without universal health care. That is obscene. WE MUST HAVE UNIVERSAL HEALTH CARE or a single payer system. We might call this Medicare for All or Improved Medicare for All. Just look how zealously people are shouting at the candidates in defense of Medicare now. Imagine if they instead had a single payer, universal system. They would never let it go. The public health community should be prominent and foremost in this battle but this is not nearly the case. How many public health contingents have shown up at Occupy demonstrations, for example? How many schools of public health or health departments have sent delegations to these demonstrations? If not us, who? If not now, when?